Association between bipolar spectrum features and treatment outcomes in outpatients with major depressive disorder

JAMA Psychiatry, 04/06/2011

Perlis RH et al. – Self-reported psychoticlike symptoms were common in a community sample of outpatients with MDD and strongly associated with poorer outcomes. Overall, the data do not support the hypothesis that unrecognized bipolar spectrum illness contributes substantially to antidepressant treatment resistance.

Methods

Open treatment followed by sequential randomized controlled trials

Male and female outpatients aged 18 to 75 years with DSM-IV diagnosis of nonpsychotic MDD who participated in Sequenced Treatment Alternatives to Relieve Depression (STAR*D) study

Results

Irritability and psychoticlike symptoms at entry significantly associated with poorer outcomes across up to 4 treatment levels, as were shorter episodes and some neurovegetative symptoms of depression

Other indicators of bipolar diathesis including recent maniclike symptoms and family history of bipolar disorder as well as summary measures of bipolar spectrum features were not associated with treatment resistance